TMS & Other Therapies

5 Things You Need to Know About Electroconvulsive Therapy


Electroconvulsive therapy, also known as ECT, is an alternative form of depression treatment that utilizes electric shocks through the brain. The electricity produces a controlled seizure for a brief period of time.

ECT is used to treat treatment-resistant depression, which has not been reduced by medication or therapy. Many laud ECT as a miracle treatment for depression, claiming it has high effectiveness and very little risk. However, this is not entirely true.

ECT comes with very real risks, some more common than others. It is not as safe as some other methods for managing treatment-resistant depression, such as Transcranial Magnetic Stimulation (TMS). And while some studies have found moderate effectiveness in the short term, others have found no improvements over a placebo, and long-term effectiveness has never been proven.

It’s crucial to know all the facts — good, bad, and ugly — before committing to a treatment plan. A recent audit found that many ECT patients are misinformed about the risks and benefits of their treatment. So if you are considering ECT for your treatment-resistant depression, here are 5 things you need to know first:

A confused woman holding her head as she sits against a tree
Amnesia is one of the most serious side effects of ECT. Patients can experience difficulty remembering things from both before and after their ECT treatment. 

1. Memory loss is a major side effect of ECT.

Memory loss is actually one of the most common and most alarming side effects of ECT. There are actually two forms of memory loss seen in ECT patients

The first is anterograde amnesia. This is amnesia affecting information learned after ECT — essentially, patients’ ability to remember new things after treatment is reduced. This side effect tends to be temporary, but it can last up to three months after treatment and interfere with one’s life in significant ways.

The other form of memory loss seen in ECT patients is retrograde amnesia. This is amnesia of information learned before ECT. Patients can lose the ability to recall important memories of personal and impersonal events. Most of this memory loss applies to events occurring close to their ECT treatments, but can extend back for months or even years. While some may recover months after their ECT treatments, others are left with permanent amnesia. 

As of now, scientists have not identified any reliable way to  predict whether or not an ECT patient will experience either of these forms of memory loss after treatment. However, it is known that women and older people are more susceptible.

A woman, her back turned, watching a hazy golden sunrise from atop a hill
Without an effective long-term treatment plan in place, your depression could fail to get better, or could even worsen. Short-term treatments such as ECT are not always enough to treat a chronic mental illness.

2. ECT may be no more effective than a placebo.

Until recently, there had not been any studies comparing ECT to a placebo (called simulated ECT, or SECT) since 1985. This is incredibly concerning, as comparing any treatment to a placebo is essential in determining its efficacy. 

In 2019, the journal Ethical Human Psychology and Psychiatry published a study in which researchers set out to compare ECT to a placebo for the first time in over three decades. As a result, they found little evidence that ECT was more effective than a placebo in the short term, and no evidence that it was more effective in the long term.

According to the study, “There is no evidence that ECT is effective for its target demographic—older women, or its target diagnostic group—severely depressed people, or for suicidal people, people who have unsuccessfully tried other treatments first, involuntary patients, or children and adolescents.” 

This is possibly the most concerning falsehood about ECT — the idea that it has been universally scientifically supported and proven to cause improvement from depression more than a placebo. Especially in the long term, ECT cannot be expected to make major improvements in the depression symptoms of all people.

Two women, one of them elderly, smiling and embracing
While there is no way to determine whether or not an individual patient will have severe adverse side effects from ECT, certain groups are more likely to experience them. This includes older people and women.

3. ECT carries the risk of death.

It is commonly believed that ECT carries no mortality risk. In fact, it is even commonly claimed that ECT “saves lives,” despite little to no evidence that the treatment prevents suicide. However, there is a risk of death due to ECT treatment.

The mortality rate for ECT is estimated to be 1 per 10,000 to 1 per 80,000 treatments amongst typical patients. This is a rate consistent with the mortality rate of minor surgeries. While death thankfully does not occur in a large percentage of ECT patients, it is still a real side effect that should be taken into consideration. 

The ECT mortality rate of those with certain medical conditions may be higher. Pregnant women, young people, and older people are considered at higher risk of adverse side effects from ECT.

A man holding his chest, over his heart, in two hands. Black and white filter.
If you have a history of cardiac disease or complications, ECT may put you at serious risk. It has been known to cause both mild and severe heart problems.

4. ECT impacts your heart health.

The electric shocks provided during ECT often cause tachycardia — increased heart rate — and elevated blood pressure during treatment. Atrial and ventricular premature heartbeats are also observed.

In some cases, very serious cardiac complications can occur. This includes heart failure, arrhythmia, and acute pulmonary edema. There are known cases of patients dying from a heart attack caused by ECT. 

Those with pre-existing cardiac disease are more likely to experience cardiac complications during ECT —  If you have a personal history of heart problems, ECT may be more risky for you.

A therapist and client, faces hidden from view, in session
ECT is considered an alternative treatment, one that should only be considered when other treatments — such as talk therapy, antidepressant medication, or TMS — have failed. Even when undergoing ECT, continuing talk therapy may prove beneficial.

5. There are varying forms of ECT.

Not every form of ECT is the same — in method or impact. There are two main types of ECT, bilateral and unilateral. 

In bilateral ECT treatments, electric shocks travel through both sides of your brain, while unilateral ECT treatments shock just one side of the brain. Unilateral ECT is often called Right Unilateral ECT, or RUL ECT, because it is most typically done on the right side of the brain.

Bilateral ECT has been found to produce more profound amnesia in patients than RUL ECT. Doctors have started to emphasize RUL ECT to diminish this side effect. However, higher strength electricity is necessary in RUL ECT, which creates concern.

A woman and her doctor talking in the office
No matter what treatment option you are considering — medication, therapy, TMS —  talk to your doctor first. They can help you to determine which methods are safest and most effective for you. 

Are There Any Alternatives to ECT?

Luckily, ECT is not the only fast-acting, non-traditional depression treatment on the market. Transcranial Magnetic Stimulation (TMS) has been found to be highly effective against depression. This is even true for treatment-resistant depression!

TMS is a non-invasive treatment, just like ECT, with fewer risks and negative side effects. It uses an electromagnetic pulse to activate areas of the brain that are less active in depression patients. Sessions last less than an hour, do not require anaesthesia, and leave patients with little more to worry about than a mild headache!

Most importantly, TMS works against depression. Many patients have found complete, long-term remission from the symptoms that held them back in everyday life.

A woman and her dog playing in bed
You deserve a long-term, fast-acting, and effective treatment that will lift your spirits and help you feel like yourself again. With TMS, your depression symptoms could be relieved in no time!

Finding the right strategy for treating your treatment-resistant depression can be difficult. You want to choose a treatment that is effective, fast-acting, long-lasting, and safe. With ECT, not all of those boxes may be checked — but with TMS, they will be.

Talk to your doctor about TMS today. You can pass on the seizure, memory loss, and heart damage, and skip straight to feeling better than ever.

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